Sunday, October 17, 2010



Boring administrative entry below.

I had the second job interview the other day.

I did the interview to get into GP training. I applied to GP training to specialise in addiction medicine. I want to specialise in Addiction Medicine because I love it, and it's fascinating, and so Sarah doesn't have to work.

On that note, we got the letter from the lawyers today. The lawyers have a website, with a short video clip of a woman talking. The woman says something like "Hi, I'm Lara Laura, Lawyer. For too long, amoral multinational companies have built their vast profits on mutilated, maimed and murdered bodies of innocent people. If you have suffered ..." and so on. It's a bit startling.

We fill in the forms and then we wait. Apparently this is an open and shut legal case, which means it may well be finalised within three years. We shall see.

Anyhow - the interview. It was the second interview, because I didn't get in on the first round - I am unsure why, but not wanting to do the thing they're interviewing you for is quite a disadvantage. I don’t actually want to be a GP – I think this is what they call family medicine over in the US. It may have been that my inability to adequately conceal this was behind my less than stellar performance in the first interview.

Still, it does hurt to fail. You do lie in bed the next few weeks wondering if they have found out what no-one else knew but you always expected – that you’re crap. I am older now, and twenty years ago I would have been swarmed by those thoughts, and dragged under, whereas now they are much fewer, and I am able to see them as not particularly realistic, but they are there.

This time things went better. The questions were about how you would handle a heart attack in a small country GP surgery, how to handle the “he’s got gonorrhoea, they’re both your patients, he doesn’t want to tell her or for you to tell her” and an unusual one that started “tell us about one of your wrong diagnoses and the consequences of that.”

It went reasonably well, and later that day they rang up and offered me the job - the job being ninety km away, doing stuff I’ve forgotten, for a minimum of twenty two hours a week, and a considerable pay cut.

Simultaneously thrilled and un-nerved. It is alarming - I don't know if I have what it takes to be a good GP, I don't know if I don't whether I will know that I do not - if you follow. I don't want to be one of those "crap at medicine and crap at detecting your own crapness" doctors. But if it all works out, in three to five years time, it’s a specialist qualification, and Sarah able to not work at all.

We shall see. More soonish - possibly about one of my patients and night terrors. Thanks for listening,


Unpublished and possibly career-ending letter to a fellow medical practitioner

Dear Dr Zu,

I saw Joanne X today. She was limping and she had many of the clinical signs of sciatica. Imagine my delight when I heard how you had successfully treated her back pain without recourse to drugs of dependence.

I'll have to imagine my delight, too, because that is not what I heard.

She said, and a call to the pharmacist confirmed, that you have prescribed her a bottle of alprazolam. I told her that alprazolam was not compatible with her other medications, because together they could cause dangerous side effects like memory loss.

She asked why I hadn't told her about this.

I told her I had.

This is the same woman you sent to me three years ago because she was addicted to alprazolam. She had nearly been intubated because of an overdose of alprazolam. Her husband and two daughters are addicted to alprazolam. The sojourn in the Barad-dur Women's Prison, the miraculously survived three motor vehicle accident, the three weeks in August sleeping in a station wagon, all are due to alprazolam. I have winched this woman's dose back to nothing over the last three years and three months ago she had what she swore was her last dose of alprazolam.

And then she strains her back and you give her alprazolam.

Sciatica occurs when an inflamed disk presses on a nerve root causing pain. The inflammation is treated with anti-inflammatories, the nerve root pain with analgesics. The only thing alprazolam is "treating" in this case is the very dependency issue that caused ninety nine percent of her problems in the first place.

She also mentioned some concerns about her weight gain. Perhaps you could prescribe her some pastry?


John Bronze,

BSc BM BS etc.

Saturday, October 02, 2010

killing people is wrong

And herein a serious post.

It's three AM. I've been up since two. One of my friends is up, and one of the writers whose recent accomplishments I most admire, and so, I believe, is that guy who wrote that book I really loved back in the eighties, but two of them are in Queensland and one is probably intoxicated, so to all intents and purposes I am alone.

The clock ticks. The cats purr. The cold air of the outside world comes in. The real world.

Today we went to see the orthopod. When I went through, orthopaedic surgeons were reputed to be particularly difficult people to deal with. I doubt that was ever true, every time we have seen one they have listened courteously and compassionately and answered every question that we've had. Today, he ran an hour and something late, for reasons I will now explain.

Two years ago, my wife became a cyborg. She has an aggressive and inadequately explained form of arthritis, along with an actual one in a million auto-immune disease. Because of this, she required surgery on both hips, to resurface the head of the femur (the thigh bone) so it moved freely and smoothly in the socket (the hip bone).

This was huge surgery. Even thinking about what went on at that time it is frightening, so I am putting it off. But it required vast amounts of blood, and pain, and courage on her part.

A few months ago I was reading in the New York Times and I read that the prosthesis (sometimes it's called the "implant") has been recalled by the manufacturer because of an unacceptably high failure rate.

I rang up. The hospital had just heard as well. We got the first available appointment, which was a month away.

In the mean time we read more. We were originally told that the implant could last decades without any trouble at all. The web was full of stories of people who had had this major orthopaedic surgery and gone on to full, astonishingly active lives - people who ran in marathons, climbed mountains, the like. I understand there was a fifth dan Shotokan in there.

It turned out that by "decades" they meant for many people, a very few years, and by "without any trouble at all", they meant something entirely different again. My wife has increasing pain and decreasing mobility. She has pain at rest which she did not have six months ago. The pain, the sleeplessness, the inability to do the things she loves, is seeping through everything. Things are as bad now as they were a year before the surgery.

That may not be all. The steel which covers her femoral head and her acetabulum is high in chromium and cobalt. In a number of cases, the metal ions are released into the surrounding tissue, into muscle, bone and fat. They cause pain and inflammation, in extreme cases they cause symptoms of themselves, they may cause difficulties with further surgery.

As an aside, I have always thought that if I was ever angry enough to want to kill someone, I should tell someone about it. That way, even if the "killing people is wrong" part of my brain didn't kick in, the "you'll get caught because you already confessed and explained exactly what you wanted to do and how you would do it" part would. Be informed, therefore, that if this goes much wronger, if, for example, something were to go wrong with the subsequent surgery, or it were to have been made impossible because of ion deposition from the current prosthetic,I feel like going to America, looking up the names of the people responsible for deciding to keep this on the market after the facts became apparent, and removing them from this earth. Without descending into hubris, I reckon I could get a couple before I went. I am smart and rich and could probably get back into shape enough to drag most people's bodies. And there would be none of this "left for dead but managed to crawl to a nearby farm" bullshit. I have called time of death enough times to know what is required.

Obviously, that's the anger talking. And the fact I have said this means I can't do it, and I haven't even been in a fight for twenty years, and yadda yadda yadda. But this anger is a difficult thing to articulate.

Anyhow. We wait on bloods, and on the ultrasound, and we go back. We see what can be done. It may be something else is going wrong. The orthopod said he could not imagine what it could be, but maybe he was having an unimaginative day. It may heal, somehow.

It may not.

Anyhow, it's nearly four. I must retire. Tomorrow I clean the chook cage, and spread compost on the fruit trees, and we set up another quail house. I will hit and gouge the punching bag, and maybe break my resolution and finish a book. And I write again soon.

Thanks for listening,